Evergreen Newsletter

March 2022

A Message from Leslie Olson, BSN, RN, NC
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Here at Evergreen Family Medicine, we want to empower our patients to manage their chronic conditions and take more control over their health and wellness. We have a licensed medical professional on staff to provide education on nutrition, exercise, and medication management; they provide 1:1 support in creating individualized goals and action plans to overcome barriers to health and improve health outcomes. Our Chronic Care professional sees patients at our Edenbower location and goes out to care homes and rehabilitation centers in Douglas County to meet our patients who can’t come into the clinic.


If you are struggling with two or more chronic conditions and would like the individualized support to be successful at managing your health, please call the clinic to schedule an appointment with our Chronic Care Services or schedule with your Primary Care Provider who can answer your questions and refer you to this service.
Leslie Olson, BSN, RN, NC

From Jennifer Estrada, Women’s Health Manager, Call Center Manager, Referrals/Medical Records Manager, Harvard Front Office Manager
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Evergreen Family Medicine and Women’s Health Care Prenatal Classes take place quarterly. For six weeks every Tuesday evening from 6 pm to 7 pm the providers from Women’s Health teach and review a variety of subjects from breastfeeding to active labor. The classes are open to all residents, if you or someone you know is interested please call Women’s Health to sign up.

Call Center has been taking on more tasks of late. They have stepped in and are supporting medical records with their buckets. As a team (medical records & call center) we were able to reduce the buckets by a couple of thousand documents.

Family Practice reception has been focusing on our AWV and CAV scheduling. Our goal is to have consistent numbers each month that will total our year end goal.

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Douglas County Communities’ Network of Care

A Message from Tim Powell, MD, CEO
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Douglas County Communities’ Network of CareIt’s a website. But describing Douglas County Communities’ Network of Care (NOC) as just a website is like calling a Lamborghini just a car.

 

The mission of the NOC is to advocate for the necessities of our community’s most vulnerable populations using technology to illuminate the pathway between serving organizations and individuals with needs. The goal is to enhance the wellness of individuals, families, neighborhoods, and communities through connectivity with existing resources.

I have been humbled by the compassion and giving I have found in this blue-collar county. Organizations large and small, public, private, religious, fraternal, and secular have identified needs and reached out with the resources they have. Organizations and foundations have been incredibly gracious with financial support. Government organizations function according to their mandates and many individuals volunteer time.

 

However, those most vulnerable are often unaware of who or how to contact the help they need. The system can appear complex, opaque, and impersonal. And there is a lack of communication between helping agencies. Help is only meaningful when it is accessible.

 

At the top of the NOC home page is a space bar with this question: what are you looking for?

 

Type in your concern. Mental health, foster kids, respite care, type 1 diabetes, dementia support, housing and shelter, food pantry, transportation, disability, senior services, nursing homes, assisted living, etc. You are immediately linked with resources within Douglas County.

 

There is an internal referral module that can be used, either by agencies or individuals. You choose the category of need and submit. If you wish a NOC navigator to help, that is available. A closed-loop function exists to ensure that referrals are tracked until contact is made and services are fulfilled. If one agency cannot fully meet the need, the user may be referred to an agency that can.

 

This webspace offers one location, where accurate, up-to-date information guides to all entities offering services to our county are compiled, along with tools provided to allow communication and tracking, all centering on that person’s need.

 

There is more: state and county health data, a library with trusted information regarding any health topic, legislative news and initiatives which allow citizens to lobby their representatives, and even the ability to create a confidential, secure, personal health record. Total connectivity at one site.

 

Most nonprofit organizations in Douglas County perform regular Community Needs Assessments at substantial costs. Have you seen one? Does anybody look at them? What changes?

 

We are one community. Why do we need 50 different community needs assessments? How do we work together if our priorities are not aligned? In 2021, the NOC coordinated a community needs assessment across Douglas County where our residents identified what was most important to them. This report is also on the website. It serves as a powerful voice to our state legislatures when it says, "this is what our county needs. And we're working on it. This is how you can help us."

The potential power behind this site is immense. But it requires two actions. The first is for every organization whose mission is to provide services to be represented on the site. The second is for the public to utilize it. Potential becomes reality when problems are solved, and citizens’ needs are met.

 

Douglas County Communities’ Network of Care is created, financed, and maintained by its founders who are Douglas Educational Service District, The Cow Creek Tribe Health Clinic, Evergreen Family Medicine, Mercy Foundation, and Mercy Medical Center, and Umpqua Health Alliance. But we don’t own it. This tool belongs to our community.

 

There is no expense to organizations to be represented on this website. We only require them to keep their own information up to date and respond to the referrals received. And there is no charge to users.

 

I am convinced there is enough money spent in this country to provide good health care for our citizens. The answer is not more funding, but improved coordination and utility of existing resources to diminish inefficiency and waste.

 

People speak of the need for a single-payer model. In fact, what I believe is needed is a single delivery system. A locally coordinated, communicating single system to organize helpers with those who need help would avoid the chaos and duplication inherent in our current structure. Systems become personal.

 

A popular term you will hear bantered about is "social determinates of health." No one doubts their significance. But while everybody can agree on and talk at length about the problem, I have seen precious few ideas toward pragmatics answers. This is one. Please check out this resource:

 

https://douglas.or.networkofcare.org/ph/index.aspx

 

Tim Powell, MD, CEO

Appointment Accelerator Comes to Evergreen 

From Ronda Powell, Edenbower Front Office Manager
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Appointment Accelerator is a program that Evergreen uses to get patients in for sooner appointments.

If there is a cancellation on a provider’s schedule, Appointment Accelerator contacts patients by text to give them the opportunity to move their appointments up to an earlier available spot.   

When a patient receives one of these texts and they would like to be seen sooner, all they need to do is be the first person to text back the appropriate word.  The automated system will then move the scheduled appointment up and send a confirmation text.  If the appointment has already been taken, the patient will receive a text letting them know the appointment is no longer available.  

If a patient chooses not to receive these types of texts, all they will need to do is text back ‘stop’ and the system will remove them from the automated list.  

Will my office visit be billed as a physical or a problem focused exam? 

Who decides? And why should I care? 
A Message from Tim Powell, MD, CEO
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Medicare, on the other hand, never pays for a "physical". If your visit is billed as a routine physical, they will pay zero. You pay 100 % of that bill. However, selected Medicare Advantage plans will pay for an annual physical. And every Medicare policy - whether regular Medicare or Medicare Advantage - will pay for an "Annual Wellness Visit" at 100%.  

Are you confused yet? Maybe it will help to explain what these terms mean in regards to what is actually intended during the office visit. Because I now answer the second question of who decides how the visit is billed.  

Criteria considered in assigning the proper billing code are two:  1. What was the main purpose of the visit?  and 2. What was accomplished at the visit?  And the responsibility for assigning that code lies with the Provider who performed the visit. As Providers, we have both ethical and legal mandates to do this correctly.  

A problem-focused exam is what it sounds like. The patient presents with a specific concern(s) or problem, such as the chest, abdominal, joint, or other pain processes, a bad cough or shortness of breath, unintended weight loss, etc - and the provider's focus is on that issue. It also occurs when the patient presents for a follow-up of an established problem such as high blood pressure or diabetes.  

A "physical" or "annual health exam" is a more general focus on both established medical and preventative issues. The providers take a broader focus on overall health maintenance. This also occurs when a patient is establishing care with a provider. It is a scheduled visit once yearly. 

 

An "Annual Wellness Visit" is limited to Medicare patients and is restricted entirely to preventative medicine including vaccinations, covered diagnostic exams, assessment of safety and function, assurance of medication list accuracy, end of life decision making, etc. 

 These visits are extremely helpful, they are paid at 100%, and Evergreen encourages every Medicare patient to take advantage of this benefit.  

The truth is that sometimes these visits fall in-between problem-focused and annual exam criteria and could be properly billed either way.  When that occurs, we will do our best to work with our patients and their insurance policy to allow coverage. We will not misrepresent the office encounter, but we do want to reduce the cost barrier to medical care wherever possible. 

We appreciate your patience and understanding of the complexity and murkiness that sometimes accompanies these decisions. Our first priority is to take care of you and your family whatever your need.  Please let us know if you believe we have not billed your insurance in the correct fashion. We may or may not be able to correct that, but we can always explain our reasoning.  

 

Sincerely,  

Your friends at Evergreen Family Medicine. 

Those are some great questions.  I wish the answers were clearer than they are. Let me start with the last question first. 

You care because the way the visit is billed greatly impacts what you owe personally as opposed to what insurance will pay. 

Most commercial insurance will pay 100% for an annual preventative exam. You pay very high premiums and have a high deductible, so it seems right to receive that benefit. This would be a good time to encourage you to read your policy or call your insurance to be certain of that coverage.

 

Mask Mandates For Health Care Offices Frequently Asked Questions

From Beth Bunt, Occupational Health Manager

Q- What has changed regarding masks at EFM? 

  • Unfortunately, Nothing.  The mandate was not lifted for health care settings in Oregon.  Guidelines still require anyone over the age of 5 to wear a mask in our buildings. 

Q-  Will EFM provide me a mask since I don’t carry them anymore? 

  • Unfortunately, no.  With appropriate medical PPE supply still limited, it is impossible to provide hundreds of free masks every day and still have supply for our own staff

 

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Q- What has changed regarding masks at EFM? 

  • Unfortunately, Nothing.  The mandate was not lifted for health care settings in Oregon.  Guidelines still require anyone over the age of 5 to wear a mask in our buildings. 

Q-  Will EFM provide me a mask since I don’t carry them anymore? 

  • Unfortunately, no.  With appropriate medical PPE supply still limited, it is impossible to provide hundreds of free masks every day and still have supply for our own staff

 

Q- What has changed regarding masks at EFM? 

  • Unfortunately, Nothing.  The mandate was not lifted for health care settings in Oregon.  Guidelines still require anyone over the age of 5 to wear a mask in our buildings. 

Q-  Will EFM provide me a mask since I don’t carry them anymore? 

  • Unfortunately, no.  With appropriate medical PPE supply still limited, it is impossible to provide hundreds of free masks every day and still have supply for our own staff

 

Q- What has changed regarding masks at EFM? 

  • Unfortunately, Nothing.  The mandate was not lifted for health care settings in Oregon.  Guidelines still require anyone over the age of 5 to wear a mask in our buildings. 

Q-  Will EFM provide me a mask since I don’t carry them anymore? 

  • Unfortunately, no.  With appropriate medical PPE supply still limited, it is impossible to provide hundreds of free masks every day and still have supply for our own staff

 

Q-  I’m fully vaccinated or have had COVID multiple times and I’m not scared, can I go without a mask? 

  • Unfortunately, no.  The mandate does not take into consideration any COVID immunity. 

Q-  Will I need a mask to pick up my prescription, get my x-ray or lab work done? 

  • The mandate requires masking in any healthcare setting including pharmacies, lab, and radiology departments 

Q-  When masks are not required in schools, will my child need to wear a mask to utilize the school-based healthcare that EFM offers? 

  • Unfortunately, yes.  Our designated areas used for school-based medical visits fall into the healthcare setting rules in the current mask mandates. 

 

Now Hiring At Evergreen!

Interested in a career in Healthcare? Evergreen Family Medicine is recruiting qualified healthcare workers with a passion for providing the best possible care to our patients and community. Visit efm.bamboohr/jobs to see current openings and apply.

Billing Tips

From Teresa Hill, Billing Manager
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Dear Evergreen Family Medicine Patients, we are so happy to be able to reach out and communicate on how we can work together to make sure that we are not only providing great care but excellent service with your billing.  Below are helpful tips that we hope will help accomplish this. 

Call or go online with your insurance and ask the following: 

Is my provider in-network or out-of-network?

 

 This can change how the insurance pays on your claim.

Does my insurance require me to choose a PCP? (Primary Care Physician)

Do you have a Co-pay? How much?

 

This is usually a fixed amount you pay whenever you receive certain health care services or get prescription drugs.   

Copays may apply before and after you hit your deductible. 

A copay is different from coinsurance, which only applies after reaching your deductible and is the percentage of your final bill that you pay. 

What is your deductible?

 

This is the amount you pay for covered health care services before your insurance plan starts to pay. 

What services are considered preventative care?

 

this is the care you receive to prevent illnesses or diseases.  These services are usually covered for free and include such things as screening and immunizations.   

Do you have primary and secondary insurance? 

Secondary Insurance is a health insurance plan that covers you in addition to your primary insurance plan. Typically, secondary insurance is billed when your primary insurance plan is exhausted and may help cover additional health care costs. For example, if you already have insurance through your employer and choose to enroll with your spouse’s health insurance plan (if allowed), that coverage would become your secondary insurance. 

It is so important to provide a copy of the insurance cards and clearly communicate which is primary and which is secondary.  

 

Make sure that you instruct that the card be applied to all family members under that plan.   

Did you know we have payment plans?  Please contact the Billing Department at 541-677-7200 ext. 4. 

COVID-19

From Kay Carlyle, Urgent Care Clinical Manager

COVID-19 Omicron variant has been making its rounds throughout our community for the last few months. Most people are recovering faster than previously seen with the Delta variant of COVID-19. During this recent Omicron surge in our community, Evergreen Urgent Care has found that individuals are generally not testing positive for COVID until symptomatic for over 24 hours. With the recent testing kit shortage, Urgent Care implemented that we are only testing adults who have been symptomatic for 2-5 days or at provider discretion. Children are only being tested if the provider determines that it is necessary. However, this does not mean that someone cannot be seen in Urgent Care for COVID symptoms. Please if you want to be seen please come in.

 

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Evergreen Urgent Care would like to also share that the guidelines to receive Monoclonal antibodies have changed. Please see below for the new guidelines.

  • Immunocompromised individuals not expected to mount an adequate immune response to COVID-19 vaccination or SARS-CoV-2 infection due to the in underlying medical conditions, regardless of vaccine status (see Immunocompromising Conditions below); or Unvaccinated individuals at the highest risk of severe disease (anyone aged 75 or older or anyone age 65 years with additional risk factors.) 

 

  • Unvaccinated individuals at risk of severe disease not included in above (anyone aged 65 or older or anyone age 65 years with additional risk factors.) 

 

  • Vaccinated individuals at high risk of severe disease (anyone aged 75 or older or anyone age 65 years with additional risk factors.) Note: Vaccinated individuals who have not received a COVID-19 booster dose are likely at higher risk for severe disease; patients in this situation within this group should be prioritized for treatment. 

 

  • Vaccination individuals at risk of severe disease (anyone aged 65 or older or anyone age 65 years with additional risk factors.) Note: Vaccinated individuals who have not received a COVID-19 booster dose are likely at higher risk for severe disease; patients in this situation within this group should be prioritized for treatment. 

 

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